{"entity":{"id":"paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013","kind":"paper","name":"MPACT (Von Hoff 2013): nab-paclitaxel plus gemcitabine for metastatic pancreatic cancer","aka":[],"tldr":"Adding albumin-bound paclitaxel to gemcitabine prolonged survival in metastatic pancreatic cancer in a large international trial, giving patients who are not fit enough for FOLFIRINOX a second effective first-line option.","summary":"MPACT randomised 861 patients with untreated metastatic pancreatic adenocarcinoma to nab-paclitaxel plus gemcitabine or gemcitabine alone. The combination improved overall survival, progression-free survival and response rate, with more neutropenia, fatigue and peripheral neuropathy that was usually reversible on dose reduction. Because it accepted patients up to performance status 2 and was less toxic than FOLFIRINOX, it became the alternative first-line standard and the backbone for many later combination trials.","asOf":"2026-09-08","links":[{"label":"Full text (DOI)","url":"https://doi.org/10.1056/NEJMoa1304369"},{"label":"ClinicalTrials.gov NCT00844649","url":"https://clinicaltrials.gov/study/NCT00844649"}],"tags":[],"related":["paper-conroy-folfirinox-pancreatic-nejm-2011"],"cancers":["pancreatic"],"sections":[],"technologies":[],"targets":[],"drugs":["gemcitabine-nab-paclitaxel","gemcitabine"],"companies":[],"institutions":[],"pathways":[],"terms":["os","pfs"],"trials":[],"people":["daniel-von-hoff"],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2013,"doi":"10.1056/NEJMoa1304369","authors":"Von Hoff DD, Ervin T, Arena FP, et al.","paperType":"rct","findings":["861 patients with untreated metastatic pancreatic cancer; nab-paclitaxel plus gemcitabine vs gemcitabine.","Median overall survival 8.5 vs 6.7 months, hazard ratio 0.72.","Median progression-free survival 5.5 vs 3.7 months, hazard ratio 0.69; response rate 23% vs 7%.","Grade 3 or higher neutropenia 38% vs 27% and peripheral neuropathy 17% vs 1%."],"whatItMeans":"With FOLFIRINOX this trial defined the two chemotherapy standards for metastatic pancreatic cancer that still apply, and the gemcitabine and nab-paclitaxel backbone is the comparator in most current first-line pancreatic trials.","caveats":["Open-label design.","The survival gain is measured in months and the disease remains one of the most lethal.","Cross-trial comparison with FOLFIRINOX is unreliable; the populations differed in fitness."],"changedPractice":true,"participants":861},"route":"/key-papers/paper-mpact-nab-paclitaxel-gemcitabine-nejm-2013/","neighbours":{"paper":[{"id":"paper-burris-gemcitabine-pancreatic-jco-1997","kind":"paper","name":"Burris 1997: gemcitabine becomes the first standard treatment for advanced pancreatic cancer","route":"/key-papers/paper-burris-gemcitabine-pancreatic-jco-1997/"},{"id":"paper-conroy-folfirinox-pancreatic-nejm-2011","kind":"paper","name":"Conroy 2011: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer (PRODIGE 4/ACCORD 11)","route":"/key-papers/paper-conroy-folfirinox-pancreatic-nejm-2011/"},{"id":"paper-halo-301-pegvorhyaluronidase-jco-2020","kind":"paper","name":"Randomized Phase III Trial of Pegvorhyaluronidase Alfa With Nab-Paclitaxel Plus Gemcitabine for Patients With Hyaluronan-High Metastatic Pancreatic Adenocarcinoma","route":"/key-papers/paper-halo-301-pegvorhyaluronidase-jco-2020/"}],"cancer":[{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"metastatic-pdac","kind":"cancer","name":"Metastatic pancreatic ductal adenocarcinoma","route":"/cancers/metastatic-pdac/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"drug":[{"id":"gemcitabine","kind":"drug","name":"Gemcitabine","route":"/drugs/gemcitabine/"},{"id":"gemcitabine-nab-paclitaxel","kind":"drug","name":"Gemcitabine + nab-paclitaxel","route":"/drugs/gemcitabine-nab-paclitaxel/"}],"term":[{"id":"os","kind":"term","name":"Overall survival (OS)","route":"/terms/os/"},{"id":"pfs","kind":"term","name":"Progression-free survival (PFS)","route":"/terms/pfs/"}],"person":[{"id":"daniel-von-hoff","kind":"person","name":"Daniel D. Von Hoff","route":"/people/daniel-von-hoff/"}],"roadmap":[{"id":"pancreatic-roadmap","kind":"roadmap","name":"Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question","route":"/roadmaps/pancreatic-roadmap/"}]}}